Tag Archives: medicine

  • Breathe, Baby, Breathe!: The Delivery

    Every year in the United States, 12% of all births are preterm births, 5% of all babies need help to breathe at birth, and 3% of neonates are born with at least one severe malformation. Many of these babies are hospitalized in a neonatal intensive care unit. Annie Janvier and her husband, Keith Barrington, are both pediatricians who specialize in the care of these sick babies and are internationally known for their research in this area. In 2005, when their daughter Violette was born extremely prematurely, 4 months before her due date, they faced the situation "from the other side," as parents. Despite knowing the scientific facts, they knew nothing about the experience itself.

    Breathe, Baby, Breathe! is the emotional and personal story written by Annie Janvier, that tells the story of their daughter Violette, alongside the stories of other fragile babies and their families with different journeys and different outcomes. In this post, we share an excerpt from the book.


    Excerpt from Breathe, Baby, Breathe!

    Part 2: The Delivery and the First Days

    The Delivery

    Violette was born at 5:21 a.m. in Operating Room 1 at the Royal Victoria Hospital in Montreal. A room that looks like so many operating rooms: too cold, highly impersonal, brightly lit. In some places, they call this an operating theatre, with the OR fluorescent blue light pointing to the main actor and to the precise spot where all the action was focused: my tsouin-tsouin. Whether there was to be a caesarean section or not, all the sick babies were delivered in that room, as the resuscitation room was adjacent to it. The “resusc” room was overheated so that babies didn’t drop their temperature. Dropping temperature is a big concern when tiny babies come out. Their little bodies are wrapped in a plastic bag or under plastic wrap in order to keep their temperature stable.

    I remembered three months back, when I was 12 weeks pregnant, nauseated and on call, that I had been urgently woken up at 3 a.m. because a 25-week baby was about to be born. After driving madly through red lights and arriving on time, I felt sick. The mother who was delivering had fulminant chorioamnionitis (a uterine infection) and the smell in the OR was not pretty. I took the baby to the resusc room. The baby stank, a tiny stink bomb, the whole resusc sauna room stank of old diapers and septic tanks. Her heart rate was not coming up with only the bag and mask. I needed to intubate her (place a tube down her throat into her windpipe). I was gagging while I was intubating this poor little girl, but managed to intubate her quickly. Thankfully I had a mask on. The junior resident asked what he could do, with both his eyebrows raised. I hadn’t worked with him before. He was still showing me what the heart rate of the baby was, and his finger was going up and down, but I guess he did not know the protocol for dealing with barfing staff, which list to check, how to assist. When the baby was stable, I asked the resident for some ice. As the main assistant for the resuscitation, he ran out to get some. I am sure he did not know why we needed ice, since we were supposed to keep the baby warm. When he returned, I asked him to place some of the ice in a plastic bag on my head. I felt like I would pass out. This baby did well, though. She was still on the unit weeks later, learning to feed, while I was pushing.

    Why was I remembering this baby while I myself was giving birth? I have often tried to understand why over the years. Maybe because I thought my situation was slightly better: I did not stink, plus my physician was not about to puke on my baby. Or maybe because I wanted to vomit with despair. Or maybe because I wanted to remind myself I was not only a failing vessel, a broken belly, the owner of an “incompetent cervix”; I was a strong physician who could intubate a tiny baby in under thirty seconds while puking in her mask. Or maybe because I wanted to think about this pretty little girl who was doing well, in our hospital, with the same care Violette would have, her little preemie-roommate.

    Credit: Sasiistock

    Axel had been born by Caesarean section, but Violette used the good old “natural route” at a highly unnatural time. So many people were around, but at that moment there could have been a TV crew, a clown, a deep-sea diver, cows, whatever, and I don’t think I would have reacted. I wasn’t supposed to be there. Why not another day, week, hour?? Why had I turned around in bed a week before, when my waters broke? That was a huge mistake. This is all a mistake, I wanted to scream. This is not happening. This cannot be my life. This is my husband next to me, with so much love in his eyes, so much despair, and so much hope. I realized it was really happening. When Axel was born, I couldn’t successfully push him out of me. I thought this would be easier. How can a 700g baby be tough to push out? Well, it was not easy. I think I pushed hard, but my OB seemed not to think so. The whole team was counting, encouraging, telling me this was serious. Maybe I was not pushing because I did not want her to come out. This was NOT a happy moment; this was one of the worse moments of my life. This was failure. A big maternal blaaaaaaaaaaah in broad florescent light for everybody to see. I felt her coming out, heard a little cry and closed my eyes. I saw Gene right there, our great colleague who was a neonatal fellow at the time. I knew Violette was well taken care of. He took her into the resuscitation room. Keith and I both knew what was happening out there. At least Gene was not vomiting and asking for ice. He intubated her when she was stable, gave her surfactant to open up her lungs and took her to the NICU. She needed only room air to breathe, 21 per cent oxygen, what healthy human beings need. I did not want to see her. I wanted to disappear. I wanted to be alone.

    Keith went to collect Axel from my mom’s place, and I was taken to the prenatal ward. I was so grateful to go there. I had been in the team recommending that all mothers of very sick babies be admitted there after birth, so they did not have to be exposed to the bright balloons, the damned joy and happiness of the other mothers, the first meconiums, the crying fullterm
    monsters, and the chattering, smiling, noisy relatives. I was with the waiting ones and the sick ones. It was silent. I went to sleep.

    May 22nd. This is the day I learned the definition of emptiness. I did not feel pain, sad emotions. I felt nothing – such a big black hole, a void. I was empty; nothing had any meaning. I learned the definition of nothing, of meaninglessness, the meaning of meaninglessness.

    A mother who is really a mother is never free.

    Honoré de Balzac


    To find out more about Breathe, Baby, Breathe!, click here.

    Annie Janvier is a professor of Paediatrics and Clinical Ethics at the University of Montreal, and a Neonatologist, clinical ethicist and researcher at CHU Sainte-Justine.

    Phyllis Aronoff and Howard Scott won the 2018 Governor General’s Literary Award for their translation of Descent into Night by Edem Awumey.

  • Understanding What Works: New Book Explores Health Innovations from Around the World

    Drawing on the analysis of over one thousand organizations engaged in health market innovations, Private Sector Entrepreneurship in Global Health is a valuable resource for researchers and students in management, global health, medicine, development studies, health economics, and anthropology, as well as program managers, social impact investors, funders, and policymakers interested in understanding approaches emerging from the private sector in health care.

    In this post, the editors of Private Sector Entrepreneurship in Global Health discuss the Toronto Health Organization Performance Evaluation (T-HOPE), a group they co-founded back in 2007. They reflect on the outcomes of that group, and discuss why ongoing commitment to improvements in human health is as important now as it was 50 years ago.


    This book is the culmination of more than a decade of collaborative work conducted at the University of Toronto, in partnership with colleagues around the world through our group, the Toronto Health Organization Performance Evaluation (T-HOPE). The work published here began when co-editors Onil Bhattacharyya and Anita McGahan joined the faculties of Medicine and Management, respectively, in 2007. We engaged students from each of our disciplines to examine the medical and management innovations of pioneering organizations from the private sector – both social enterprises and non-profits. This led to insights about how some private sector pioneers applied management techniques in finance, operations, and marketing to achieve breakthroughs in health outcomes in resource-limited settings.

    In 2010, Will Mitchell and Kathryn Mossman joined the team, and we partnered with Results for Development (R4D) to explore how broad health outcome measures contrasted with the organization-level process and profitability metrics that were customary in our fields of medicine and management. The field needed criteria that reflected differences in the strategies, sustainability, and scale of the innovative organizations that we sought to assess. We wanted to develop a reliable framework that was widely applicable to assess the effectiveness of organizational choices.

    To accomplish this, we engaged with a committed, inquisitive, and capable group of students from medicine, social science, public health, management, and global affairs. The T-HOPE team worked on a series of projects focused on understanding how organizations around the globe are innovating to improve healthcare, particularly for the poor. In everything we did, we sought to adhere to strong scholarship while translating our research to findings that would be useful in practice and policy.

    This book reflects the outcome of that decade-long effort. Key themes include:

    • Managing trade-offs between access, quality, and efficiency: Credible and feasible measures to guide strategy are essential to create health value in new ways and to apply innovative approaches.
    • Localization: New tools that reflect local needs and local resource constraints are available to support innovative organizations, especially those that seek to address the specific concerns of small communities.
    • Reverse innovation: There are growing opportunities to learn from different contexts and apply innovations from other parts of the world, including diffusion from resource-constrained contexts, in higher-income countries such as Canada.
    • Technological leverage: Digital health tools can improve access and empower patients and providers.
    • Sustainability: Sustaining impactful health innovations requires innovative financing, partnerships, and approaches to cost structure.
    • Scaling: Scaling up innovative approaches begins with generating demand, and is fulfilled by excellence in execution.
    • Management is central to healthcare: Many of the problems facing healthcare are management problems, creating the potential to revolutionize healthcare through innovative approaches to the central management issues of organizational processes, finance, and marketing.
    • Public-private complementarity: Critically, health innovators from the public and private sectors must work together to coordinate and integrate care to maximize impact.

     

    Our core message is simple: private sector organizations, including for-profit social enterprises and non-profit NGOs, play a large role in delivering healthcare in many countries. Harnessing the capabilities and activities of these organizations can help achieve sustainable healthcare for those who need it most. A range of organizations in the private sector have implemented technical, organizational, and management innovations that provide healthcare and promote health in a range of settings. These innovations can inform healthcare in other settings.

    While we see public sector agencies and initiatives as essential to the planning and sustainability of health care globally, we also acknowledge that public sector organizations face resource limits, political challenges, organizational constraints, and other barriers that can limit their impact. In turn, we highlight the value that private sector organizations can bring to health globally – by testing and scaling new models that fill gaps in care, and by acting as a source of replicable solutions in other settings. Private-sector organizations can extend the reach and impact of public organizations. Through greater coordination, collaboration, and integration, public and private providers can work together to ensure that quality care is accessible to those who need it most around the world.

    Globally, a great deal has been accomplished during the past half century to improve healthcare and strengthen health systems. On average, average life expectancy has increased by 20 years since 1960, while infant mortality dropped by 35 children per 1,000 births since 1990. Despite this success, huge gaps in access and quality remain in all countries – both on average and in the lives of individuals. Indeed, improvements in many countries have plateaued, and in some cases even been reversed, during the past decade. Moreover, health challenges that once were isolable now have global implications – the cross-border diffusion of the Ebola virus is one obvious example. Ongoing commitment to improvements in human health is as important now as it was 50 years ago.


    Anita M. McGahan is University Professor and George E. Connell Professor of Organizations and Society at the University of Toronto, where she is appointed at the Rotman School, the Munk School, the Physiology Department of the Medical School, and the Dalla Lana School of Public Health.

    Kathryn Mossman is Associate Director of Research and Strategy at iD. As an anthropologist and research consultant, her areas of interest include global health, gender and immigration, knowledge translation, insights and strategy, and organizational effectiveness.

    Will Mitchell is the Anthony S. Fell Chair in New Technologies and Commercialization at the Rotman School of Management of the University of Toronto. He studies business dynamics in markets around the world.

    Dr. Onil Bhattacharyya is a family physician and the Frigon Blau Chair in Family Medicine Research at Women’s College Hospital. He is an Associate Professor in the Department of Family and Community Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto.

  • Diagnosis: Truths and Tales Book Giveaway

    CONTEST ALERT! Annemarie Goldstein Jutel's new book has been getting a lot of buzz since its recent release, and we thought you'd want to see what it's all about.

    Diagnosis: Truths and Tales shares stories told from the perspectives of those who receive diagnoses and those who deliver them. Confronting how we address illness in our personal lives and in popular culture, Jutel's book explores narratives of diagnosis while pondering the impact they have on how we experience health and disease.

    Want a copy for yourself? From July 2-7, follow us on Instagram, like our post announcing the book giveaway, and tag a friend. You'll be entered in a draw to win a FREE copy of Diagnosis: Truths and Tales!


    Terms and Conditions

    Open to residents of Canada (excluding the Province of Quebec)

    1. CONTEST PERIOD: The 2019 University of Toronto Press Instagram contest commences at 12:00 PM Eastern Time (“ET”) on July 2, 2019, and will end at July 7, 2019 (the “Contest Period”). All times are Eastern Times.
    2. RULES: By entering this Contest, entrants agree to abide by these Contest rules and regulations (the “Official Rules”). The decisions of the independent contest organization with respect to all aspects of the Contest are final. These rules are posted at https://utorontopress.com/ca/blog/2019/07/02/diagnosis-truths-and-tales-book-giveaway/.
    3. ELIGIBILITY: To enter the win the Contest and be eligible to win a Prize (see rule 6), a person (“Entrant”) must, at the time of entry, be a legal resident of Canada (excluding the Province of Quebec) who has reached the age of majority in his/her province or territory of residence. The following individuals and members of such person’s immediate family (including mother, father, brothers, sisters, sons, daughters, partner or spouse regardless of where they live) or persons with whom they are domiciled (whether related to the person or not) are not eligible to enter the Contest: employees, officers, directors, shareholders, owners, general and limited partners, agents, representatives, successors.
    4. HOW TO ENTER: During the Contest period, follow @utpress on Instagram, like the post that pertains to the Contest, and tag a friend. Limit one (1) entry per person per day during the contest Period regardless of method of entry. Any person who is found to have entered in a fashion not sanctioned by these Official Rules will be disqualified.
    5. PRIZE: The winner will receive one (1) print copy of Diagnosis: Truths and Tales.
    6. DRAW:
    7. The random draw will include all eligible entries, and will take place on July 8, 2019 at 12:00 PM at the University of Toronto Press offices, located at 800 Bay St. Mezzanine, Toronto, Ontario, M5S 3A9.
    8. The winner will be contacted via social media, and will be included in the announcement on Instagram. If a selected Entrant cannot be reached via social media within 7 days of the draw, then he/she will be disqualified and another Entrant will be randomly selected until such time as contact is made via social media with a selected Entrant that satisfies the foregoing requirements or there are no more eligible entries, whichever comes first. University of Toronto Press will not be responsible for failed attempts to contact a selected Entrant.
    9. CONDITIONS OF ENTRY: By entering the Contest, Entrants (i) confirm compliance with these Official Rules including all eligibility requirements, and (ii) agree to be bound by these Official Rules and by the decisions of University of Toronto Press, made in its sole discretion, which shall be final and binding in all matters relating to this Contest. Entrants who have not complied with these Official Rules are subject to disqualification.
    10. CONSENT TO USE PERSONAL INFORMATION: University of Toronto Press respects your right to privacy. The information you provided will only be used for the purpose of administering this Contest and prize fulfillment. For more information regarding University of Toronto Press’s privacy statement, please visit https://utorontopress.com/ca/privacy-policy.

     

  • The Sentence: The Transformative Power of Storytelling in Diagnosis

    In the diagnostic moment on story is told and another one is triggered. Hon. John Collier. No. 177. Royal Academy and Paris salon. Credit: Wellcome Collection.

    Imagine the following scene. You’ve had some symptoms that worried you. You’ve gone to the doctor who agreed that a diagnostic work-up was in order. You’ve had an X-ray, maybe a scan, and some blood work run. The results are back, and you are in the doctor’s office, awaiting the verdict. On the one hand, you’re thinking “It’s probably nothing. I’ve just been overworked recently.” On the other, you are asking yourself, “Suppose it’s something serious?”

    We have probably all rehearsed this kind of scene in our heads. What would we do/say/think/feel if the doctor were to say “I’m sorry to have to tell you this, but you have [name of dire diagnosis].” We might have a list of activities to tick off, people with whom to reconcile, places or things to do or see.  Just getting a diagnosis ends up dividing as Suzanne Fleischman wrote: “a life into ‘before’ and ‘after,’ …[a division]… henceforth superimposed onto every rewrite of the individual’s life story.” She wrote this after her own diagnosis of what was to be a fatal leukemia.

    Imagining this story is not hard, if we haven’t experienced or witnessed it before, because the diagnosis is so common a device in stories of all kinds. Diagnosis is, in itself, a story. It links together a set of phenomena in a usually linear manner, it generates an explanation, a plot line, and a denouement, in which a knotted bundle of threads gets untangled.  It is a trope, or a motif. The stories of diagnosis are told in a particular tone, with an expectation of a particular kind of outcome. This is why we can imagine the diagnostic scene. We’ve seen in before in many other guises: a sombre newspaper report about a celebrity learning about an unexpected cancer, a book in which the protagonist must wrestle with the knowledge of his newly-announced disease, a film in which the main character watches her life wind down after learning she has an early-onset dementia. The picture accompanying this post barely needs a caption. We can recognize this scene.

    Thinking about diagnosis as a story gives us opportunities. Any story can be retold, or reframed. There are many narrative templates, and not all are linked to devastating change.  Importantly, thinking of diagnosis as a story, we have an opportunity to release ourselves from the dominating grip of diagnosis-as-verdict, diagnosis-as-moment-of-truth.

    How about we move away from the contemporary tendency of narrative constructions, be they about diagnosis or something else, to focus on personal change. It is a tendency that my friend and novelist Damien Wilkins laments, as it “leaves out other ways of being in the world.” It’s not that transformation stories don’t have their place, but there are other ways of telling stories.  Save the powerful about-turns for when they matter, he argues: “the notion of personal change – change which is improving – is both disreputable and unmoveable, tarnished and resolute, art’s cheapest trick and its most generous gift.” [i]

    Narratives don’t always have to promise change.  If we hearken back to the Greeks, the dominant narrative form focused on observing what happened to people as they endured trials. The trials were administered by fate, and rather than transforming the characters, they revealed them. They ride on, and through, the chaos of life, with only fate as immovable.  In contrast to the change narrative (like the moment the doctor is going to tell us the name of some dreaded malady), it is not a moment where a power structure is revealed. The narrative affirms, rather than changes the character.

    Diagnosis: Truths and Tales focuses on revealing the prevalence of the change narrative to which diagnosis clings, highlighting its transformative power, and suggesting a re-narration that will make the experience of illness something easier to bear.


    [i] Damien Wilkins, "No Hugging, Some Learning: Writing and Personal Change," in The Fuse Box: Essays on Writing from Victoria University’s International Institute of Modern Letters, ed.  Emily Perkins and Chris Price (Wellington: Victoria University Press, 2017).


    Annemarie Goldstein Jutel is Professor of Health at Victoria University of Wellington.

  • #BalanceforBetter: Our Top Titles for International Women's Day

    This International Women’s Day, who will you celebrate? From radical housewives to the future of work, from violence to trafficking to politics and law, this week we’re highlighting top titles that celebrate women’s achievements, participate in a larger conversation, and reflect diverse and global voices.

    On March 8, we’re joining groups worldwide in the call for a more gender-balanced world.

    Let's turn the page.


    Disrupting Breast Cancer Narratives: Stories of Rage and Repair

    Resisting the optimism of pink ribbon culture, these stories use anger as a starting place to reframe cancer as a collective rather than an individual problem. Emilia Nielsen looks at documentaries, television, and social media, arguing that personal narratives have the power to shift public discourse.

    Female Doctors in Canada: Experience and Culture

    The face of medicine is changing. Though women increasingly dominate the profession, they still must navigate a system that has been designed for and by men. Looking at education, health systems, and expectations, this important new collection from experienced physicians and researchers opens a much-needed conversation.

    Wrapping Authority: Women Islamic Leaders in a Sufi Movement in Dakar, Senegal

    Since around 2000, a growing number of women in Dakar have come to act openly as spiritual leaders for both men and women. Learn how, rather than contesting conventional roles, these women are making them integral parts of their leadership. These female leaders present spiritual guidance as a form of nurturing motherhood, yet like Sufi mystical discourse, their self-presentations are profoundly ambiguous.

    Women and Gendered Violence in Canada: An Intersectional Approach

    A significant expansion on the conversation on gendered violence, this new book from Chris Bruckert and Tuulia Law draws on a range of theoretical traditions emerging from feminism, criminology, and sociology. Find compelling first-person narratives, suggested activities, and discussions on everything from campus violence to online violence to victim blaming.

    The Talent Revolution: Longevity and the Future of Work

    This book is a first. Two women from different generations debunk commonly held myths about older workers, showing how the future of work requires engaging employees across all life stages. Work-life longevity is the most influential driver transforming today’s workplace – learn how to make it a competitive advantage.

    Indigenous Women’s Writing and the Cultural Study of Law

    How do Indigenous women recuperate their relationships to themselves, the land, the community, and the settler-nation? Through a close analysis of major texts written in the post-civil rights period, Cheryl Suzack sheds light on how these writers use storytelling to engage in activism.

    Responding to Human Trafficking: Dispossession, Colonial Violence, and Resistance among Indigenous and Racialized Women

    In the first book to critically examine responses to the growing issue of human trafficking in Canada, Julie Kay reveals how some anti-trafficking measures create additional harms for the very individuals they’re trying to protect – particularly migrant and Indigenous women. An important new framework for the critical analysis of rights-based and anti-violence interventions.

    Becoming Strong: Impoverished Women and the Struggle to Overcome Violence

    What role can trauma play in shaping homeless women’s lives? Drawing on more than 150 in-depth interviews, Laura Huey and Ryan Broll explore the diverse effects of trauma in the lives of homeless female victims of violence. This essential read offers not only a comprehensive examination of trauma, but also explores how women may recover and develop strategies for coping with traumatic experiences.

    Lissa: A Story about Medical Promise, Friendship, and Revolution

    Two young girls in Cairo strike up an unlikely friendship that crosses class, cultural, and religious divides. The first in a new series, Lissa brings anthropological research comes to life in comic form, combining scholarly insights and rich storytelling to foster greater understanding of global politics, inequalities, and solidarity.

    Ms. Prime Minister: Gender, Media, and Leadership

    News about female leaders gives undue attention to their gender identities, bodies, and family lives – but some media accounts also expose sexism and authenticate women’s performances of leadership. Offering both solace and words of caution for women politicians, Linda Trimble provides important insight into the news frameworks that work to deny or confer political legitimacy.

    A New History of Iberian Feminisms

    Both a chronological history and an analytical discussion of feminist thought from the eighteenth century onward, this history of the Iberian Peninsula addresses lost texts of feminist thought, and reveals the struggles of women to achieve full citizenship. Learn what helped launch a new feminist wave in the second half of the century.

    Radical Housewives: Price Wars and Food Politics in Mid-Twentieth-Century Canada

    This history of Canada’s Housewives Consumers Association recovers a history of women’s social justice activism in an era often considered dormant – and reinterprets the view of postwar Canada as economically prosperous. Discover how these radical activists fought to protect consumers’ interests in the postwar years.


    Want to keep learning? Visit International Women’s Day for more details about this year’s #BalanceforBetter Campaign.

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